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Intravesical therapy for bladder cancer

With intravesical therapy, the doctor puts a liquid drug directly into the bladder (through a catheter) rather than giving it by mouth or injecting it into a vein. This could be either immunotherapy, which causes the body’s own immune system to attack the cancer cells, or chemotherapy.

Medicines given this way mainly affect the cells lining the inside of the bladder, with little to no effect on cells elsewhere. This means that any cancer cells outside of the bladder lining, including those that have grown deeply into the bladder wall, are not treated. Drugs put into the bladder also can’t reach cancer cells in the kidneys, ureters, and urethra, or those that have spread to other organs.

For this reason, intravesical therapy is used only for non-invasive (stage 0) or minimally invasive (stage I) bladder cancers.

Intravesical immunotherapy

Bacillus Calmette-Guerin therapy: Bacillus Calmette-Guerin (BCG) is the most effective intravesical immunotherapy for treating early-stage bladder cancer. BCG is a bacterium that is related to the germ that causes tuberculosis (TB), but it does not usually cause serious disease. BCG is put directly into the bladder through a catheter. The body’s immune system cells are attracted to the bladder and activated by BCG, which in turn affects the bladder cancer cells. Treatment is usually started a few weeks after a transurethral resection of the tumor and is given once a week for 6 weeks. Sometimes long-term maintenance BCG therapy is given.

Treatment with BCG can cause symptoms that feel like having the flu, such as fever, chills, and fatigue. It can also cause a burning feeling in the bladder. Rarely, BCG can spread through the body, leading to a serious infection. One sign of this can be a high fever that does not get better when you take a pain reliever (such as aspirin, ibuprofen, or acetaminophen). In such cases, you should see a doctor right away. These infections can be treated with the antibiotics used to treat TB.

Interferon: Interferons are substances naturally made by several types of cells in the body that stimulate the immune system. They can also be made in the lab and given as medicine. Interferon-alpha is the type most often used to treat cancer. It can be helpful in the intravesical treatment of bladder cancer.

Possible side effects include muscle aches, bone pain, headaches, problems with thinking and concentration, fatigue, nausea, and vomiting. These problems are usually temporary and improve after treatment is completed. Other drugs may be given along with interferon to lessen these side effects.

Intravesical chemotherapy

For this treatment, chemotherapy (chemo) drugs are put directly into the bladder through a catheter. These drugs kill actively growing cancer cells. Many of these same drugs can also be given systemically (usually into a vein) to treat more advanced stages of bladder cancer.

Mitomycin and thiotepa are the drugs used most often for intravesical chemotherapy. Other drugs that can be used include valrubicin, doxorubicin, and gemcitabine. Delivery of mitomycin into the bladder along with heating the inside of the bladder, a treatment called electromotive mitomycin therapy, may work even better than giving intravesical mitomycin the usual way.

A major advantage of giving chemo directly into the bladder instead of injecting it into the bloodstream is that the drugs usually do not reach other parts of the body. This helps people avoid many of the side effects that can occur with systemic chemo. An exception to this is the drug thiotepa, which rarely is absorbed from the bladder and can cause side effects in the rest of the body.

The main side effects of intravesical chemo are irritation and a burning feeling in the bladder.